Department of Metabolism & Endocrinology, Juntendo University Graduate School, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Department of Endocrinology, Diabetes and Metabolism, Fujita Health University, Toyoake, 470-1192, Aichi, Japan.
BMC Endocr Disord. 2024 Aug 6;24(1):143. doi: 10.1186/s12902-024-01664-8.
Arginine vasopressin deficiency (AVP-D) can occur due to various conditions, so clarifying its cause is important for deciding treatment strategy. Although several cases of AVP-D following coronavirus disease 2019(COVID-19) infection or COVID-19 vaccination have been reported, the diagnosis of the underlying disease has not been reported in most cases.
A 75-year-old woman who presented with polydipsia and polyuria 9 weeks after contracting COVID-19 and 5 weeks after receiving the SARS-CoV-2 vaccination, leading to the final diagnosis of AVP-D 8 months after the first appearance of symptoms. Interestingly, pituitary magnetic resonance imaging (MRI) still revealed stalk enlargement frequently observed in patients with SARS-CoV-2 vaccination-induced AVP-D. Although this finding could not rule out any malignancies, we additionally measured anti-rabphilin-3A antibodies, a known marker for lymphocytic infundibulo-neurohypophysitis (LINH), and found that the results were positive, strongly suggesting LINH as the cause of this disease. Thus, we avoided pituitary biopsy. At the follow-up MRI conducted 12 months after the initial consultation, enlargement of the pituitary stalk was still observed.
We experienced a case with LINH probably induced by SARS-CoV-2 vaccination. In SARS-CoV-2 vaccination-related LINH, unlike typical LINH, there is a possibility of persistent pituitary stalk enlargement on MRI images for an extended period, posing challenges in differential diagnosis from other conditions. Pituitary stalk enlargement and positive anti-rabphilin-3A antibodies may help in the diagnosis of AVP-D induced by SARS-CoV-2 vaccination.
精氨酸加压素缺乏症（AVP-D）可由多种情况引起，因此明确病因对决定治疗策略很重要。虽然有几例 COVID-19 感染或 COVID-19 疫苗接种后发生 AVP-D 的报道，但大多数情况下并未报告潜在疾病的诊断。
一名 75 岁女性，在感染 COVID-19 后 9 周和接种 SARS-CoV-2 疫苗后 5 周出现多饮和多尿，最终在症状出现 8 个月后诊断为 AVP-D。有趣的是，垂体磁共振成像（MRI）仍显示出在 SARS-CoV-2 疫苗接种引起的 AVP-D 患者中经常观察到的柄部增大。尽管这一发现不能排除任何恶性肿瘤，但我们还测量了抗 rabphilin-3A 抗体，这是淋巴细胞性漏斗状-神经垂体炎（LINH）的已知标志物，并发现结果为阳性，强烈提示 LINH 是导致该病的原因。因此，我们避免了进行垂体活检。在初次就诊后 12 个月进行的随访 MRI 检查中，仍观察到垂体柄增大。
我们遇到了一例可能由 SARS-CoV-2 疫苗接种引起的 LINH。在 SARS-CoV-2 疫苗相关的 LINH 中，与典型的 LINH 不同，MRI 图像上垂体柄增大可能会持续较长时间，这在与其他疾病进行鉴别诊断时带来了挑战。垂体柄增大和抗 rabphilin-3A 抗体阳性可能有助于诊断 SARS-CoV-2 疫苗接种引起的 AVP-D。
